Challenge Your Exam Readiness With Our Free Nutrition Support Clinician Practice Questions

Head-of-bed elevation to 30–45° is a cornerstone strategy to reduce aspiration risk during gastric EN, particularly in ventilated ICU patients. Semi-recumbent positioning lowers reflux and microaspiration of gastric contents. While checking gastric residual volumes (GRVs) is common, aggressive GRV thresholds and frequent checks can interrupt feeding without clearly preventing pneumonia; many protocols de-emphasize routine GRVs in favor of clinical assessment (abdominal distention, emesis). Continuous feeding rather than bolus can also reduce aspiration risk in high-risk patients, but posture remains the single most impactful, universally applicable measure. Additional strategies include oral care, subglottic suctioning when available, prokinetic agents (metoclopramide/erythromycin) for feed intolerance, and considering post-pyloric feeding in patients with persistent high aspiration risk. Fiber addition helps bowel regularity and microbiome health but does not specifically mitigate aspiration. Consistent head-of-bed elevation should be part of standard EN safety bundles.